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Growing readmission rate sparks concern around early discharge

11 February, 2013 | By The Press Association

Concerns have been raised that hundreds of thousands of older patients are being sent home from hospital before they are well enough, after new figures showed that emergency readmission rates have doubled in the last decade.

The number of over-75s in England who have to undergo emergency readmission to hospital hit 201,000 in 2010-11, research conducted by data experts Ssentif Intelligence revealed.

The figure is a stark rise from 2001-02 when the readmission rate for this age group stood at 103,000 a year.

A shocking 16% of all over-75s need emergency readmission within 28 days of discharge, Ssentif said.

But performance around the country varies significantly. Readmission rates in the South West are 12.98% and in London the figure stands at 17.06%.

Ssentif said Northumberland Tyne and Wear NHS Trust, Birmingham Women’s Trust and West Middlesex University Hospital Trust all reported readmission rates of more than 20% - meaning one in five over 75s treated at the trusts could have been sent home prematurely.

Across all ages, 650,000 patients were readmitted as an emergency in 2010-11 - a considerable rise from 380,000 patients in 2001-02.

Campaigners said that inappropriate discharges often involve patients going home without proper support in place.

Katherine Murphy, chief executive of the Patients Association, said that high readmission rates are both costly for the NHS and distressing to patients.

She said: “These figures showing rising readmissions are of huge concern for patients.

“Too often patients, relatives and carers contact our helpline about inappropriate discharges, with patients being sent home without proper planned care in place, at a time when they are incredibly vulnerable. This sadly leads to readmissions, and sometimes even more tragic consequences.

“We need a more integrated NHS, so that readmissions don’t continue to lead to poor patient care and huge financial costs to the NHS. Urgent action is needed to bring down these unacceptable figures.”

Judy Aldred, managing director of Ssentif, said: “One of the main reasons for the increase in readmissions is the lack of community health services available to patients after discharge.

“These services were historically provided by primary care trusts but during the reorganisation of the NHS, many of the community services during the time these figures were collated would have been in the process of moving organisations.

“Many community health services are now provided by the very trusts showing these readmission figures. It will be very interesting to see if the government’s reorganisation plans work and readmission rates drop in the next few years as the same organisations will provide both inpatient care and community care.”

A West Middlesex University Hospital Trust spokeswoman said: “Over the past year, West Middlesex has been working closely with the primary care trust and local authority to improve the care pathway for older people, with a particular focus on preventing avoidable readmissions.

“We have established a specialist team of nursing and therapy staff who assess the needs of older patients when they arrive at the hospital, to ensure that all of their care and support needs are met during their stay and that their discharge is safe and they are full supported once they leave hospital.”

I was just thinking about this this morning. surely it is more economical in the long term to allow patients longer to recuperate in hospital before being discharged. in the old days hospitalisation was longer, although obviously other factors were involved, such as less advanced treatments and care as compared with now, for example, even though the healing process for each individual may not have altered that much.

They're really on the ball these researchers... readmissions due to early discharge caused by bed shortages date back to Thatcher's time. For their undying shame New Labour under both Blair and Brown did nothing to reverse the situation.... Far to busy fighting their illegal wars I suppose!

I work in A&E and often see patients who have been discharged in the previous 24 hours. Often the decision to discharge has been made at short notice or on a weekend. This means that care packages are not set up properly to support elderly patients once they get home and the emergency services end up picking up the pieces.

Re-admissions following early discharges are just false economy, speaking metaphorically and in todays climate, realistically. The trouble with the NHS is they don't look any further than the end of their noses. Every solution is made for the current situation and not with a longer view in mind. It's about time the issue of re-admission rates was adressed. I am sure more cumulative hospital days are taken up by these unfortunate patients, who are often sent home to fail. Frankly it is scandalous. I can't stand labels that are given to the elderly, eg. acopia (what the ....?) and 'bed blockers, etc. How disrespectful. "The use of this kind of terminology and the sloppy thinking it exemplifies would be considered professionally unacceptable in younger, fitter patients, and it should be equally unacceptable for the old and the frail." Ref: ‘Acopia’ and ‘social admission’ are not diagnoses: why older people deserve better: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2312388/. Journal of the Royal Society of Medicine. 2008 April 1; 101(4): 168–174.I was talking to a colleague in oncology the other day, and patients were being sent home and their chemo treatment cancelled to use the bed for another person. I don't deny the other person needed a bed, but it is just cooking the books to boost their 'activity' at the cost of what could be a patient's life.